Per Fugelli Lecture 2021: The decolonizing power of planetary health

Seminar (full text)

Introduction by Anne Kveim Lie

Dear students, dear colleagues from near and from afar and dear Charlotte Fugelli and all of his friends and admirers. My name is Anne Kveim Lie and I'm an associate professor at the Department of community medicine and global health at the University of Oslo and on behalf of the organizing committee for the Per Fugelli lecture series consisting of Espen Bjertness, John Arne Røttingen and myself and our departments, as well as all the student’s organizations and the center for Global health

For organizing this meeting I hereby welcome you to this year's Per Fugelli lecture. A special welcome to Renzo Quinto and listeners from the Philippines who are joining us very late at night. I'm so glad you can all be here. Today would have been a 78th birthday and I am convinced that somewhere out there he is smiling, content that this year, in this age of covid-19 and climate change we will be hearing the voice and ideas of the next generation of planetary and Global Health leaders. Just one practical detail before we start. There will be an opening for questions from the audience in the Final Round Table discussion so I encourage you to post questions in the Q&A box at the bottom of your screen while listening to Renzo's talk.

But now, I would like to give the word to the vice rector at the University of Oslo, professor of medicine: Per Morten Sandset, who will open the event and the introduce this year's speaker. The floor is yours vice-rector.

Opening by Per Morten Sandset

Thank you very much. As the vice rector at the University of Oslo, it is my pleasure to welcome you all to this year's Per Fugelli lecture, this year focusing on planetary health, decolonization and global health. The covid-19 pandemic has really demonstrated how dependent and how connected our societies are on a global scale. It has in fact been the convergence of several crises. It is not only a health crisis, but also a political, economic, financial and not at least a climate and nature crisis. The distribution of existing and emerging infectious diseases in humans is affected by destruction of the nature and the environment, deforestation and changing use of land areas and diseases in animals. Natural diversity is already drastically reduced and this will have consequences for health in the future. Human-made climate change and environmental changes are not only one of the biggest societal change challenges of our time, but also amongst the biggest threats to Public Health, both to the health of us living here today and to that of future generations. Nature devastation and climate changes have resulted in rising temperatures, reduced food and water supply, increase in air pollution and frequency of vector-borne diseases, with acute and chronic diseases as a result.

Climate changes as well as the pandemic are not affecting all of us in the same manner. Climate changes increase the risk of exacerbating and widening is the existing social inequalities and disproportionately affecting the health of vulnerable populations such as the elderly, children, women, those living with chronic medical conditions and people with low socio-economical status. As the global climate crisis aggravates an increasing number of people are being forced to flee their homes due to natural disasters, such as droughts and other weather conditions. Therefore at the University of Oslo we are working to create a comprehensive climate and environment strategy. It is our bold ambition that UiO shall lead the way in environmental work, both nationally and internationally, and act as a role model for other institutions.

Climate change, nature laws and social inequality are major global challenges, where the University's many disciplines can and must play an important role in finding solutions. Per Fugelli was a pioneer in holistic thinking around the climate and health crisis. In his famous 1993 paper “In search of a global social medicine”, on which this lecture series was built, he argued for our attention to what he called “Patient Earth”, but also for solidarity as a basis for global health work. This lecture series is created to honor Per Fugelli, but also to continue and substantiate the cause he developed in this 1993 paper. Starting his academic career in general practice, Per got the professorship in social medicine at the University of Oslo in 1991. As a professor of social medicine, he ventured into a career as a public intellectual, speaking up against what he saw as and as social injustice, both within medicine and in society. Per quickly gained a position in a Norwegian public as few academics do. People in marginalized positions, like substance abusers, undocumented migrants or the poor, felt that they had in him a spokesperson. We think that Per would have been very pleased that we have this year's speaker among young, promising and passionate colleague has taken up his challenge to rescue the patient Earth.

Renzo Guinto is one of the emerging leaders in global health research, advocacy and education, and has an impressive track record giving his young age. Working at the nexus of global health and sustainable development, Renzo obtained his Doctorate in Public Health from the Harvard University and doctor of medicine from the University of the Philippines, Manila. Currently he is an associate professor of the St. Luke's Medical Center of medicine in the Philippines.

He is a member of several international groups, including the Lancet One Health commission and The Lancet Chatham House Commission on improving population health post covid-19. He sits on the editorial board of important journals in the field of planetary Health in global health and he acts as a consultant for various international organizations. So as the vice rector of the University of Oslo, dedicated to promoting the sustainability agenda and international collaboration, and as a medical professional myself, I am therefore very pleased to welcome you all to this year's Per Fugelli lecture. Renzo Guinto,  the floor, I must say, maybe the screen is yours. Please.

Lecture by Renzo Guinto

Thank you very much Per and of course Anne and of course to the University of Oslo for this amazing opportunity and this honor that you've bestowed upon me by allowing me to deliver the 2021 Per Fugelli lecture. Let me just share my screen. Do this you know now we live in a zoomfied world and it's just amazing that despite the lockdowns and the mobility restrictions there's no stopping us from having this, convening this you know ability you know the ability to come together, to discuss some of the most pressing challenges of our time, but also to come up with solutions and I think the covid-19 pandemic has shown us that we can overcome many of the world's challenges and hopefully the challenges that the year of planetary health is currently bringing to us. Good evening from Manila, I'm actually joining you from the Philippines. It's close to midnight here, but when I invited the invitation from the University of Oslo, it's just so hard to say no to such an important and amazing honor and an invitation and that's why I hope that in the next couple of minutes, I'll be able to convey to you my ideas, my experiences, my aspirations and my visions for a decolonized planetary health Future.

So you know we're going to talk about the decolonizing power of planetary health. And first I just want to reminisce first my visits, my previous visits to Oslo, to the University of Oslo, to Norway Per already mentioned some of my affiliations and my activities, and some of them are in relation to the University of Oslo and so I have a special relationship and I've had a special relationship with the University of Oslo. I think since 2012, you know and when I was just about to graduate from medical school and you know I can see in the audience that you know some of our friends are here, of course John Arne Røttingen will be moderating the panel later, I'm really privileged to be having a conversation with him later, but also I can I can see Jeanette Magnus also in the audience and of course I have other friends who are affiliated with the University of Oslo of course. Inger Skil who I also consider as a very good mentor and friend, who used to head the Secretariat of the Lancet University of Oslo Commission on global governance for health, it was chaired by your former rector Ole Petter Ottersen, who's also a good friend and colleague. And you know I was involved in that commission, I actually was the one who nudged the University of Oslo colleagues to establish a youth commission that will shadow the main commission comprised of the world's global Health experts and leaders and so it was the first Lancet commission to actually have a youth commission, and since then a few succeeding Lancet commissions have actually ensured that the young people of the world and the next generation of scholars and practitioners are engaged. Of course right now, as already mentioned by Per, I'm actually involved in the Lancet One Health commission. I can see Ingeborg here, and of course our other colleagues, Andrea Winkler, who is chairing the commission and I'm really privileged to be part of this amazing group that is headquartered in University of Oslo, that is envisioning the future of One Health, of planetary health, to make sure that this pandemic is the last of its kind and that we are able to tackle some of the pressing challenges at the nexus of human, animal, plant and environmental health. So as you can see those are my pictures in the University of Oslo. I think that one is a main building, I believe, of the University of Oslo and I hope that you know when the situation becomes more stabilized I can visit again Oslo, Norway and all them the beautiful cities of your country. I've been to four already from Tromsø, the northernmost part of Norway, all the way to beautiful Bergen, so that's just my intro to establish my deep connection with your country. Of course I'm really really honored and privileged to be delivering this lecture in honor of a great physician, a great planetary health visionary. Anne referred to Per Fugelli a while ago, he must be smiling you know, at us right now, as we gather together, as we Gather today to commemorate his 70th birthday and you know I happen to encounter this beautiful photo of his smiling beamingly, surrounded by greens, by nature and I think that you know here in this picture we can feel and and sense his infectious energy and his passion for life, for you know for helping others. And I think that in this era of covid-19, of the climate crisis, what we should be aiming for is to be like Per Fugelli, to be a doctor, not just for people and planet and Per already referred to the 1993 article that he wrote “In search of a global social medicine” where he was talking about not just the human patient but also patient Earth and actually it's very interesting because I only heard about, I only encountered this article very recently, but even since last year I've been using this slide, to describe my practice and my mission as a planetary health physician that in this day and age I am not anymore just treating one kind of patient, that young kid wearing a mask protecting herself from the unseen coronavirus. I think in the era of the Anthropocene, in the era of climate change and covid and many of these other contemporary challenges we now have a second patient, Mother Earth, also wearing her mask not the protect herself from SARS-CoV 2, but to protect herself from the human induced damage that we are afflicting towards her or onto her, because of the many activities that we do as part of our civilization and so I think that Per Fugellis, message that was articulated more than almost three decades ago, are still ring true today and perhaps it's more important now than ever before. Of course I also want to acknowledge that I'm giving this lecture following a very prestigious and stellar roaster of global health and planetary health leaders and when Anne actually sent to me the list of former and or previous Per Fugelli lectures I was, you know starstruck because one these are like the who's who of global health and planetary health. I was asking Anne why me, you know why not another global health either who's been working in the WHO or in many of the major global health organizations. Interestingly all the former Per Fugelli lecturers I've met in person. Some of them I've had really good interactions with, some of them were my teachers at Harvard when I was doing my doctorate and a few of them I actually work closely with in many different initiatives and as you can see I didn't have a picture with the others but at least I have had pictures when four of them: Vikram Patel world leader in mental health, of course Paul Farmer, who always has reminded us about social medicine and health equity, Richard Horton, perhaps the most popular editor-in-chief of a journal in the world, whose not just an editor, but really a global health activist and of course Andy Haynes, the former director of the London school, which is one of the pioneers of the field of planetary health and so I just want to acknowledge that I am a young, emerging scholar, who is following in the footsteps of these amazing people, and I hope that more young people like me, perhaps you are right now in the audience in the zoom will feel it inspired by their example and will also become important contributors to the advancement of our collective health.

So you know this is me, before the pandemic, I go around the world, I go around the Philippines, I go around southeast Asia to really promote and spread the gospel so to speak of planetary health. You know I've been working closely with you know leaders and policymakers to make sure that planetary health knowledge really gets translated into policies and practice, because that's what's really important, that we get to impact the lives of communities and nations and of the entire world. I love teaching, you know I don't think I will be removing my teaching responsibilities regardless of what I do in my career and whichever station in life I would be, because I think teaching and mentoring is our way to really transmit the knowledge and to make sure that the next generation is much better than us, but also I love, as you can see interacting with young people.

I am energized by their infectious spirit and creativity and innovation, and I also love sharing my knowledge and experiences to young people, so that they feel inspired, those who find their you know, create their dreams and shape their visions for the future and pave you know world-changing solutions to our pressing problems. And so this is my past life in the pan pre-pandemic, but that has not stopped us, in trying to really spread the good news of planetary help, thanks to zoom, thanks to all these teleconferencing platforms and hopefully from 2022 onwards we will continue our work, whether it's virtual or physical and I hope to be able to visit again Oslo and Europe at large.

So today as you have seen in the program the title is: The decolonizing power of planetary health, and some of you might be familiar with one of the terms in the title, I will try to cover both of them and explore the nexus, the connections between the decolonizing global health and the new field, the new paradigm of planetary health. Even before the pandemic but especially during this pandemic I've seen myself basically having my two feet standing in these two different worlds. One foot standing on this decolonizing global health movement and another foot standing on this exciting and growing and continuously expanding arena of planetary health. I think these two concepts, these two powerful ideas have very strong connections and this is what I wish to convey to you through this talk.

So first decolonizing global health. You know when I went in late 2018 was the first time I tweeted the hashtag #decolonizedglobalhealth, so if you go back to Twitter and you try to look which tweet use that hashtag first, you will see my tweet, although definitely I am not the one who started this conversation about the decolonizing global health. These discussions have been happening for many years, if not the past decade. But most especially during covid-19 I think the whole global health community was confronted with this huge question: How can we decolonize, how can we tackle the many power asymmetries that you know shape and that characterize our field, our sector, global health science, global health policy. And in this slide you will be seeing some of the articles that were published during this covid times, that really ask these questions that identify different aspects of this, you know vast, you know theme around decolonizing global health. It's covid-19 magnifying colonial attitudes that have been existing for some time, if not for nearly a century in global health and international health and tropical medicine. You know we've seen anecdotes like French doctor saying can we test the vaccines on africans, and of course we now know that Africa is still very much in need of the covid-19 vaccine and of course there are a lot of discussions about the top down in positions of policies from Geneva all the way too many low and middle-income countries. And so this discussion was really, has been existing for some time, but covid-19 reinforced, further emphasized and even opened a window for further discussions and deep reflection within our community and I urge our colleagues from the University of Oslo and Norway in general and everybody else in the audience to continue reflecting on how we can decolonize our field. And it's part of this bigger movement which I, you know, described here as decolonizing everything. We want to decolonize, you know, mental health decolonize our diets, returning to indigenous diet.

Decolonizing our buildings, removing any reference to the slave owners or racist colonialists from the past, decolonizing humanitarian aid or the way we are being educated. And so this is not a unique phenomenon of global health, it's happening in all sectors, but I think especially in global health, it has become very important, because right now we are still grappling with perhaps one of the biggest if not the biggest global health crisis of our age. And when we talk about decolonizing global health, a lot of people think about ensuring that are, you know, there's representation in global health leadership and decision-making and financing. Representation along gender, racial, geographic, political, religious and other kinds of lines and I always say that right now and even until today, despite the discussions around decolonizing the field of global Health, global health is still being owned, being decided upon, being controlled by “quote on quote” the old, white, senior old boys club of global health, and no disrespect meant to colleagues who are in the zoom who might fit the bill, but I'm talking about the you know the the infrastructure, the institutions that still govern the global Health system.

And you know at the bottom you will see there this is one thing that we can all do, and we can all do this now, not tomorrow. We should be rejecting Manels, all man panels, Whanels, all white panels and HICanels, all high-income country panels. You know male, white, high-income country experts, all talking about women's health in Africa. That should be made obsolete in the 21st century in the day and age of Covid.

So we should not be seeing pictures like this anymore and perhaps even in our webinars we should ensure that there is wide and diverse representation of voices. And also as I've already said it's not really just about the people, it's all about the institutions. And this is a work of global Health 5050 which is headquartered in the University College London. I sit in its Advisory Board and as you can see just by eyeballing this map, most of the global Health power lies or is concentrated in North America and Europe and this is global health which is meant to serve the Global South, low and middle-income countries, the rest of the world's poor and so we need to be asking the question, we need to keep on asking the question is global health leadership truly global. This is also part of the decolonizing debate.

And of course, it's not just the people, it's not just as institutions, it's also about the frameworks, the theories, the language, that we use in the field and of course we always say and as you know this a while ago I also hesitated whenever I use the words Global South, Global North, you know these terms have colonial legacies, they you know just very briefly that these terms actually came out for the first time of a report in the 1960s, headed by the former German Chancellor Willy Brandt you know. As you can see there's a Brandt line dividing the world into Global North and Global South. Until today we use these terms, you know, and this is the only map perhaps where Australia is in the north and of course we know that Global North is, pertains to not just a geographical location, but also where resources and power you know lie, and that still continues until today, this Divide, and so we need to interrogate the language, but also the reality from which these ideas and concepts emanate.

And of course, it's not just about the old colonizers still continuing their control and power over institutions, over countries, over the global health system. And I am introducing the idea of neocoloizers in global Health, some of them may say “oh we are part of the decolonizing movement, we are decolonizing ourselves, we have very diverse representation in our board, whether it's an editorial board or an advisory board, but they are still exerting enormous and disproportionate degree of power and decision making in financing and Global health. And as you can see here, this is just a sampling of the logos of organizations that may be classified as neocolonizers, from philanthropic organizations, foundations transnational corporations, consulting firms or even schools of public health and global health, maybe also accomplice to the coloniality of global health.

And of course, when we talk about covid-19, we will be remissed not to talk about the vaccine inequity and vaccine apartheid that still exist until today, perhaps this is the most you know visible and most glaring manifestation of the colonial ability of global health. You know you can see an entire continent there, almost white without access to the lifesaving covid-19 vaccines, which by the way was earlier suggested to be experimented on them, as I already mentioned in an earlier slide. And so we really need the tackle the covid vaccine inequality that we are still seeing today, and that means and that includes really decolonizing our policies, our institutions, our decision-making and of course you know this vaccine inequality, if not Addressed, will continue to give birth to variants of concern, as we know and of course right now everyone is concerned about Omicron that has already been detected in many countries, but see these news articles that have been published over the past week. You know a caricature or a cartoon in a Spanish newspaper showing, you know, the Omicron virus in with black skin right or brown skin and meanwhile another newspaper use this title “The government is hunting for African visitors”, so the Omicron virus is just a manifestation of the unfortunately long-standing and intrinsic and deeply embedded coloniality of global health affairs.

So when we talk about decolonizing global health, we're really trying to tackle and dismantle these manifestations of power and privilege, white supremacy and saviouism, racism, patriarchy, you know, coloniality, lack of diversity, equity and inclusion, all of these emanate from the asymmetries of power that characterize our world today, so we cannot talk about decolonizing Global health by just doing cosmetic changes in our organizations, in our boards, in our, you know, in adding more African sounding names in the byline of our article and you know we can submit that to a journal and say oh this is a decolonized article. We need to get to the root cause of all of these you know colonial manifestations, and that means tackling power and privilege that exists in our system until today.

So that is decolonizing global health, and you know usually that's like an hour-long lecture, compressed in a 15-minute or a ten minute segment. But we should not forget that there is also another form of colonialism that we need to address, and it's not just the colonialism of global health as a field and as a sector. It's not just a the colonialism that is manifested in global health academia or practice or policies or financing. It's also about the colonialism of the human civilization over nature. You know, we've not only colonized our fellow brethren, you know, our fellow people, other country's, indigenous peoples, we´ve also colonized ecosystems, the environment. They have colonized animals in the wild, as you can see in that old picture from the past. But we've also colonized the atmosphere by injecting and pumping you know gigatons of carbon and other greenhouse gases into the atmosphere that led to the destabilisation of the global climate system. This is the other colonialism, contemporary colonialism, that we need to tackle today, and we've not only colonized the environment, we´ve also colonized the future. We have colonized our future children who are yet to be born, we've colonize the ability of these future inhabitants of planet Earth to be able to live and thrive, and so as you can see there, at the bottom it was written by Roman Krznaric who wrote the book “The Good Ancestor”, “We treat the future like a distant colonial outpost devoid of people, where we can freely dump ecological degradation, technological risk, nuclear waste and public debt. So this is colonialism that transcends you know temporal lines. We've also colanized the climate, as I also mentioned already a while ago, we have colonized the atmosphere, but we've also colonized the climate debate. We´ve colonized climate science, as you can see there Reuters released last year a list of top 1000 climate scientists. Only five are African and all five of them are white and men. And we've also colonized the climate negotiations, you know everybody was you know saying that the Glasgow conference last month in that the UN climate change conference COP26 was a success it kept the 1.5 degrees Celsius Target of the Paris agreement alive. But I think that we could have done better, and that there are many voices that have not been heard in COP26, just like in many of the past COPs for the past 25 years. My dream is COP27 becomes, it becomes a COP of the health sector, the COP of indigenous peoples, the COP of young people and we've also colonized the movement. We've seen the tokenizing, the tokenism of indigenous communities in these important convenings. As you can see there, at the bottom, why is the climate change movement so white? And we've also colonized the solutions, because our Industries, even our governments, even our international institutions have been peddling false solutions to the climate problem. “Oh we can just offset our emissions by planting more trees”, as if the trees can grow quickly and they can sequester carbon from the atmosphere as soon as possible. That's not going to happen and that is what is being described here as greenwashing. We can come up with greenwashed solutions to problems that are truly systemic in nature and that requires systemic transformational change.

And the other manifestation of the colonialism of the climate, of the plant and of the planet is that the health impacts are unfairly distributed. This is a classic slide coming from the WHO. It's never been updated since two decades ago, but I think that the message still rings true until today. As you can see at the top the parts of the world that are magnified are the countries and the regions of the world that have emitted the greatest amount of greenhouse gases into the atmosphere.

North America, Europe and much more recently China as the biggest emitters, meanwhile at the bottom you will see the parts of the world that will be bearing the brunt, suffering the health consequences of climate change. The entire continent of Africa, South Asia, many parts of Asia and even in the end, even the Pacific Islands, although as I always say the Pacific Islands here are probably already erased from the face of the Earth. That's why you can't see them at all, and they're very small to be magnified in this map, and so as you can see the victors or the emitters and the victims are quite different. And this is how the colonialism of the climate is resulting in the further colonialism of the victims of the climate crisis. So let me bring you to my part of the world, which is a climate and health hotspot. This is Southeast Asia, it's already night here in Southeast Asia, as I've already mentioned and in this map the redder the country is, the most the more vulnerable the country is to climate change and unfortunately my home country, as you can see the Philippines is the reddest of them all. It is expected and it's already experiencing huge, you know climate hazards and risks, and later on I will be showing some slides about these challenges. I´ll pause for a bit, because instead of I giving you a lengthy talk about the Philippines, I want you to, I want to to bring it to the Philippines. Sadly you can travel here that the Philippines to enjoy our natural ecosystems because of the, you know covid-19 pandemic hopefully after the pandemic you can visit me and enjoy my country, but if climate change continues to worsen you might not be able to see some of these natural wonders anymore because climate change is going to wreak havoc into our natural ecosystems which in turn will impact the health of our Filipino population. So I'm going to show to you a short film, it's 5 minutes long, and it will capture the experiences of Filipino communities living in the coastlines, but also the solutions that they are trying to mount in response to the climate crisis. So this films this is a two-part film, I'm showing you part 1. These were part of my doctoral dissertation at Harvard, and what I did was I turned my dissertation into half written and half film, and the written part has only been read by my three member Committee, but my films have been seen by tens of thousands around the world. So I will show the film, the part one of the film right now. Let me just shift my you know slide to the film.

Just a moment. One more second and I see it now. Okay so I'll just go back to my slides.

So that's the Philippines and you've seen not just the problems, the challenges that people are experiencing, but also the solutions you know the resilience of the communities, that the interventions that they're mounting. Even if they have nothing to do with the climate crisis, you know they've not emitted a lot of carbon into the Atmosphere, but that brought them so many challenges that they are trying to weather and survive, even during the time of covid-19. So you know, I just want to share that in the Philippines we've seen firsthand the confluence of covid-19 and climate change. You have Filipinos, many of them poor and underserved, who are confronted by a dilemma, on one hand do I stay in the house to protect myself from the unseen coronavirus, but perhaps the house might get inundated by extreme flooding or affected by, you know, the roof might get thrown away by the strong wind. On the other hand do you move to this evacuation centers, temporary shelters, safe from the climate-related extreme weather events that I mentioned, but facing a very high risk of contracting the unseen coronavirus, because as you can see here, in this picture, there's no social distancing to begin with. So these are real experiences, we're not talking just about, you know, numbers and hypotheticals here. And this scene in the film that the water from the sea is already intruding into freshwater systems. There's this lady talking about water or that is already high in salt and there's growing evidence in the literature that the intake of water that is high in salt is leading to a wide array of health effects from you know hypertension to kidney disease to preeclampsia and impacts on the newborn. And the Philippines is already seeing the fastest rate of sea level rise in the world compared to many different coastlines and archipelagos.

And here you will see that I'm sorry you will see that the Philippines or Manila, the capital city, is at risk of being underwater by 2050 if climate change is not going to be stopped, again because of sea level rise and coastal flooding, and not only the waters are affected but also the ambient temperature. We are expecting hotter weather in Asia in general, also in the Philippines in particular, and this may lead to the epidemic. New epidemics of heat-related illnesses and surges in emergency room visits due to heat stroke and other heat related emergencies that we're already seeing in Europe and in North America as well. And here are other major cities in our region that are expected to also become inundated because of sea level rise and coastal flooding. And of course you know we're talking about covid-19 we're having this discussion now in covid times, and climate change and ecological destruction are all going to make the likelihood of another pandemic even higher. As you can see Asia in general is a hotspot for emerging infectious diseases, so we need to address these pandemics at the source, and that also means tackling the upstream drivers such as climate change and biodiversity loss. And you know we talk about climate change, but  we should also talk about other planetary issues that the world is confronting, and you know one important framework to the health of the planet is a planetary boundaries framework that was introduced by the Stockholm resilience centre, which is your neighbor. And just by looking at it, in this diagram, two out of nine of the planetary boundaries that have been identified have already been breached. Biosphere integrity or biodiversity because over the past century we've seen the fastest rate of extinction of creatures great and small and the other boundary that has already been violated is the the biogeochemical flows of nitrogen and phosphorus, because of our addiction to artificial fertilizers as part of large-scale agricultural production. Snd then you can see that there are other two that are in yellow, climate change which we've already extensively discussed, and land system change because we've been destroying natural ecosystems and been turning them into cities and farmlands and you know other forms of human habitation.

And so four out of the nine are already in danger. Two already have been breached, and so this is the state of our planet and we know that this will have grave consequences to the health of human populations in the years and decades to come. And so of course right now, I'm sure we're all worried about the first wave of covid, the second way, perhaps some parts of the world already in the third or the fourth wave covid-19. But we should also be equally, if not more afraid and concerned about not just the waves, but the tsunamis of long-term health consequences that climate change and ecological destruction will be bringing in the coming years and decades. And these are really just manifestations of the same problem. Earlier we talked about the need to decolonize global health, to decolonize everything. I talked about the coloniality of climate change as a movement, as a science, we've colonized nature and all of them really are traceable to you know the phenomenon and the experience of colonization, and colonization and colonialism have been manifesting in many different arenas. As you can see there are different types of supremacy, white supremacy, over other people's of color, indigenous peoples, male supremacy over women and other gender identities and even non-conforming gender identities, and of course human supremacy, which is supremacy of the human species over nature and as you can see there what we're really doing to the climate system is ecocide.

All of these need to be addressed and we need the back of the root cause which is the coloniality of our social systems. And I think planetary health and so now I'm moving to the last part of my talk. I think planetary health is the way to really decolonize the global health system and ultimately our relationship with one another in a relationship with a planet Earth, and I already earlier a while ago, you know describe my practice in my mission as treating two patients, both people and planet and that is what planetary health is all about. I think planetary Health has a very strong and innate decolonizing power it calls us the shift from an egological point of view or approach, as you can see there we've always seen ourselves as being on the top of a pyramid of nature. We can consume, we can pollute, we can mine, we can extract, we can kill other species that constitute this great planet, and instead it's calling us to shift towards a truly ecological approach. And ecological means democracy, a holistic view, a living in solidarity and interdependence with all creatures great and small, and even with the abiotic or nonliving components of planet earth.

And planetary health, while it sounds knew it was introduced or reintroduced by the Lancet Rockefeller commission's report in 2015, planetary health in its purest form, in its true meaning, it's not a novel invention. We can go back to indigenous communities, to ancient wisdom and for millennia these communities these peoples have already acknowledged and recognized the inextricable link between the health of people and the health of the planet. As you can see here in this quote from Chief Seattle who is an indigenous leader of the Americas “The Earth does not belong to man; man belongs to Earth. Man did not weave the web of life, he is merely a strand in it. Whatever he does to the web, he does to himself”. This is not a new idea, this has already been acknowledged by many ancient indigenous communities and we just need to listen to them more, and to include their voices. And this is a real, another article that we copublished with colleagues several months ago. We should now start listening to other cultural traditions. You know as I've mentioned already a while ago. I´m from Asia and from the Philippines, and we believe that the truly decolonized discourse,  decolonized global health, the decolonized planetary health, we need to incorporate all of these voices and I invite you to take a look at this article, which is about the contribution of Islam to planetary health, and I believe that other cultural and religious traditions are already also looking at how they can enrich and contribute the discourse around healthy people and healthy planet. They're now seeing a grand convergence, not just of different cultural traditions and religions and philosophies and epistemologies, you know but also different sciences you know, and here you will see, you know global health and even One Health and we can have a discussion later on if you know you have questions about the differences between One Health and planetary health, but you know at least in this depiction you can see that all of these things that we already know are just coming together towards a grand convergence around planetary health, the health of the human civilization and of the natural ecosystems on which it rides.

But to achieve planetary health we need to tackle the colonial economy that we have now, and I invite you to take a look at this article that I published a month ago “The economy that planetary help requires”, we need to renovate, we need to decolonize the political economy of planetary health, we need to shift from this old thinking about the economy that it can be represented by a limitless supply and demand curve, that we can consume and consume, and pollute and pollute and produce and produce. As if the planet does not have any limits, and instead we need to shift towards this new kind of economy that I'll describe to you in this next slide. Of course during this pandemic times we've seen the enormous need for PPEs, personal protective equipment and we need and we still need more of them, but I think the other PPE that we need is a people and planet centered economy, an economy that protects the planetary boundaries that I described to you a while ago, but also ensures that there's health and wellbeing for everybody, not just for a few. That we're able to meet the social foundations and I invite you to read the book Doughnut economics, which I believe should be required reading for every planetary health citizen, steward and leader in the 21st century because Doughnut economy shows to us the kind of economy that we need, an economy that is in the safe and just space, that green zone between the ecological ceiling, which we should not exceed and the social foundation below which we will be having huge problems for humanity.

And I invite you to take a look at the study by the University of Leeds. They try to answer the question. If we're going to assess all the countries of the world which one is closest to becoming like a doughnut economy, and just by eyeballing you will see that the US and unfortunately your country Norway. Yes you've achieved almost every component element of the social foundation, but as you can see you've also exceeded almost every planetary Boundary. You've exceeded your planetary boundary budget, as you can see there's plenty of reds outside. My home country the Philippines has not exceeded any of the planetary boundaries but if you have lots of shortfalls when it comes to the social foundation as you can see, plenty of reds inside and then as you can see there's a country that is three hours by flight away from Manila, Philippines, that has been deemed by this research as being closest to becoming like a doughnut economy, and that is the country of Vietnam, only violated one planetary boundary, the planetary boundary of climate change, only to a very certain, very minimal degree and is almost done, accomplished already, in terms of achieving the social foundation, so perhaps a question we should also be asking now is how can we be like that now, how can Norway and the US reverse ecological damage while retaining the high level of social foundation and how can the Philippines improve the social foundation, while not exceeding the planets boundaries. These are the core questions of our time. We need the decolonised planetary health education through, so it's not just the economy but also the way we educate the next generation, and I invite you to this new framework that was published by the Planetary Health Alliance and educational framework for planetary health. And as we speak there are many institutions around the world, perhaps even the University of Oslo is considering to establish The planetary health program, a course, a module, a unit and an institute, but all of these are based in the Global North, in North America and Europe, and so in our pursuit to decolonize global health, we need to make sure that planetary health does not repeat the same mistake of global health, and that's why in the Philippines established the first planetary and global health program. In the Philippines at the St.Lukes Medical Center College of Medicine, at the top academic Medical Center of the Philippines. And only a few months ago and I know Tan Sri dr. Jemilah Mahmood is actually in the audience, Jemilah and I established the Sunway Center for Planetary Health in Malaysia, and we hope that this new center will be a huge contributor and player in terms of advancing planetary health in Asia and the world. We want to recast a partnership between people and planet so that both can thrive. And the news center is embedded in the Sunway University, one of the youngest, most Innovative and fastest growing universities in the world, basic Malaysia, and the university has made a commitment to become the first planetary health oriented university in the world right now. We are revising the curriculum and we are developing a core module in planetary health, that every student, whether you're from accounting or culinary school or engineering or nursing, all students will be taking, so that they can be prepared and equipped to become planetary health oriented citizens, and in the Philippines to establish planetary health Philippines, which is our growing community for planetary health which also introduced the community in the Lancet and planetary health Philippines is a community of that is interdisciplinary, intersectoral, international, we are also having Filipinos who are part of the diaspora and also intergenerational, young and old from 16 to 60 can be part of this community, because we want and our vision is to make the Philippines not the Silicon Valley, you must be familiar with the Silicon Valley in California,the epicenter of technological innovation, but instead to make it the Silicon islands of planetary health innovation. You've seen in the film the many islands of the country and we hope to become the wellspring of solutions to planetary health challenges. So I'm nearing the end of my talk and of course, while we're still fighting this pandemic, we need to keep on flattening the curve of covid-19. We also need to expand and enhance or increase the capacity of the healthcare system by adding more beds, recruiting more health professionals, purchasing more medicines and rolling out more vaccines. But there is also another curve that we need to flatten, and that is the curve of our ecological footprint and our carbon emissions.

And unlike the previous curve, as you can see in this curve, the earth's capacity is unchangeable. It's constant and therefore it's non-negotiable, there's no increasing of beds or rolling out of more vaccines in order to expand the capacity of the planets boundaries. So the only option that we have is to lower emissions and bend our ecological curve. We need to take advantage of the post covid recovery process in order for us to reach a green, healthy and just future. And lastly, and I already implied on this a while ago, you know that we've decolonized the future,  we´ve decolonized the future children of the world, we´ve decolonized their ability to live and thrive, and I already mentioned this book already a while ago, by Roman Krznaric. We are called to become good ancestors, ancestors that are, that do not have a colonial mindset, but answer stores that have a planetary health ethos.

This book is treaty against short-termism and a call for long-term thinking. And basically what it's telling us is that in 2121, what we want to happen in 2121, which is a century from now, 100 years from now, what we want is that the children of 2121 will read the history books and we look back to the past, and they will say that the covid-19 generation of 2021, which is all of us In this zoom, we're good ancestors to them because we've made the right decisions not just for ourselves, but for their health and well-being as well. We owe it not just to ourselves, but we owe it to these children. This is a picture taken here in the Philippines. Children carried in these containers to protect them from both covid and climate, and we also owe it to the future children of the world who are yet to come. So together, let's advance the health of people and planet, let's be good ancestors, let's decolonize and let's embrace planetary health. And I would like to end by showing another short clip. As you know all the Physicians recite the Hippocratic oath or the physicians pledge before they enter medical practice, and last year a group of us actually revised the Hippocratic oath and turned it into a planetary health pledge, a pledge for health professionals in the Anthropocene, and I want to show a short clip showing Filipino professionals reciting this new pledge, and just give me a moment.

Thank you very much.

Thank you.

Thank You from Anne Kveim Lie

Aahh you´re ready, sorry, sorry, I can't understand that Renzo, so thank you so much for such an inspiring, fascinating lecture. So now we have, we're a bit behind schedule but that's fine. So I suggest we take 5 minutes break so that you can grab your coffee and go to the bathroom or anything, but please join us in five minutes at 16 15 and to hear Ågpr deliver her commentary and then we will have a final round table discussion with students and Ågot and headed by John Arne Røttingen and Renzo, so headed by John Arne Røttingen, and please for those of you do not need that coffee break, please spend that time writing in the Q&A because that will, we will be heading to those questions in the final round table discussion. So see you in a minute!

So I hope you all got your coffee and ready for the next session. So now it's my, thank you again Renzo. It's my pleasure to introduce Ågot Åkra. She is the executive director of the division for climate and environmental health, which is actually pretty new, this division at the Norwegian Institute of Public Health. Her scientific background from this is in biotechnology and microbiology. She received her PhD from the Norwegian University of Life Sciences, with a thesis on diversity and phylogeny of soil bacteria. So please, I'm so happy that you're here Ågot! Welcome, the floor is yours.

Commentary, by Ågot Aakra

Thank you Anne, and thanks to you and the organizers for inviting me to this event. It´s really a great pleasure to be here and we are kind of well, it's an understatement, your kind of, it's been really a pleasure to listen during so thank you for sharing your great thoughts and views and I think you have addressed many global challenges and we have already set the agenda for the COP27 I think, so at least part of it. Well you said that little bit about why I'm here Anne Helene. I'm leading the division for climate and environmental health at a Norwegian Institute of Public Health (NIPH). This unit was established a few months ago, while the Institute was and still is struggling with the pandemic. I think that's actually a very correct priority. We cannot postpone building knowledge, preparedness and infrastructure to handle the largest global health crisis of all, the climate crisis. And we at the Institute of Public Health, we aim to take a new role regarding climate environment, food and health. And Per Fugelli´s words, they could have been written today, the patient Earth is sick and it's sicker than it was in 1993. There is a big team trying to help, Per said, ecologists, economists, environmental, activists, politicians, but the medical doctors are mainly absent. The impact of the disruption of natural ecosystems on human population health may be profound. It is therefore essential to call upon doctors to give a world diagnosis and help the treatment. It could have been written today and if you could also have been published today even. I do believe it would have been accepted by editors in several journals today. As Anne said, I'm a microbiologist by training and I've been working with ecologies for many years and with systems thinking and the circle of thinking in main principles, so I couldn't be more, agree more with Per and Anne.

The United Nations has addressed the main challenges with the defining the 17 sustainability goals. They are the joint plan to eradicate poverty, fight inequality and stop climate change by 2030. 2030 that's not far away, it's only eight years from now. And the sustainability goals and the work towards achieving these goals, they illustrate the main principle, also addressed by Per, you have to collaborate, you have to think system, you cannot only think the sector. The 17 sustainability goals, they are very closely interacting with each other, the work towards one goal affect the work towards all the goals and that's also what Renzo has shown so perfectly during his talk, and actually when talking about sustainability. The 17 sustainability goes, they are the agenda 2030, but we all know that the 1992 Rio conference, that was when the sustainability term was really launched worldwide. I started my studies at Ås, NMBU, in 1993, that was actually the year that Per published his papers and that time we have several courses named so-called sustainable production, sustainable agriculture and so on, and as new students we were told that sustainability, that's a one of concept, we have to find another word, and many of the courses were renamed and called instead green or environmental or something like that, but 30 years later sustainability is back, and it will stay. So I'm often asked by young people why should we address climate change and health in Norway.

Well Norway, the northern sphere, and we are close to the Arctic, we cannot hide. December this year is cold, but that's no excuse. The climate changes will affect us and they already do. Mitigation another patient, will be priorities for public health in Norway as well.  Our law writers have also given us a mandate to work with climate change and health. We have an article in our constitution, the 112^th, where environmental health is addressed. It says everyone has rights to an environment that ensures health and to a nature where productivity and diversity are preserved and so on. So, and it's also a duty for the state authorities to implement measures that include all these principles. As I said the NIPH, the Norwgian Institute of Public Health have three main thoughts, that's building knowledge, that's getting preparedness and infrastructure to handle the largest the global or the public health crisis, and the global health crisis is among them. We do know that the human influence of the warming in the atmosphere, on the sea, on land and the extense and speed is larger than we have ever seen. Many of the changes we have seen, they are irreversible and we have to cope with them. Climate change and health is among and NIPHs main strategic priorities, we would like to take a new role in matters of climate, environment, food and health. We will develop new knowledgeable on causes, risks, health effects and measures based on our expertise and infrastructures, such as health examinations, laboratories and biobanks. A main priority for us in the Institute will be to work with sustainable and and climate adapted food systems. We want to strengthen our knowledge about food which is healthy, safe and sustainable in a global perspective, and among our priorities within this climate change and health efforts, is also to make it clear to the population what consequences climate change actually has for public health I think we have a main task to do there.

I cited the Per Fugellis paper, he said medical doctors are mainly absent, but all they really absent? I don't think they really are, probably we can see now that there is a change and medical doctors and  climate or health systems are about to prioritize questions regarding climate and health. The Lancet countdown report has been published annually since 2015 and the latest report was published this autumn. Along with this report there also came a policy brief for Norway as a collaboration between the University of Oslo, the NIPH and NMBU at ÅS, there was a short note on the policy for climate change and health in Norway. In this paper ,there was three recommendations, clear recommendations from the researchers and  the people writing this the short brief. We should develop public risk analysis for physical and mental health coupled to climate change. Health emergency preparedness and response plans must consider events caused by climate change and disruption of ecosystems, and media is encouraged to convey climate change as a public health crisis. Right, that's very important measures that we can take to raise the problems regarding climate change and hope in Norway.

We also see that the editors in scientific journals worldwide they take action regarding climate change and health. This autumn there was published a paper by several editors for leading medical journals. They call for emergency action to limit global temperature increases, restore biodiversity and protect health. They say wealthy nations must do much more and much faster. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have then been bringing attention for decades. So reflecting on the severity of the moment, this editorial that was published this autumn appeared in health journas across the world, and the editors were united in recognizing that only fundamental and equitable changes to societies will reverse or change trajectory we are on now. We also have seen the publication of the first part of the sixth assessment report of the International Panel for climate change (the IPCC), that was published in August. That holds the physical science basis for climate changes, and the coming spring there will be a second report from the IPCC, which says something about impacts, adaptation and vulnerability to climate changes. In this report they will show a lot of how the changes will affect us worldwide, and I think this coming report will receive the same amount of attention as the first report did, because that would show us all how the climate changes will affect everyday life, everyday infrastructure and so on.

And also the medical or the public health institute are now taking action regarding climate change and health. During the COP26 in Glasgow, the international Union of Public Health Institute (IUPHE), they published an action plan on engaging and supporting the National Public Health Institute as key climate actors. In this action plan the IUPHE recognizes climate change as a major threat to the health and well-being of the world population. They say that IUPHE aims to strengthen the world's National Public Health institute's at key climate actors and IUPHE commits to actions to improve climate change and public health interventions. So I think that's a very great statement that IUPHE has addressed and that they were also able to launch this in the COP26. So I´m coming to the end of my commentary here, and I'm going back to the National Institute of Public Health. We are actually part of the efforts to reduce the or to be prepared to take the consequences of the climate changes on public health. We also know that our ministry is now taking action after the COP26. The Norwegian Health Ministry have launched climate commitments in the health field, which we are really looking forward to how the government will follow up. In the Norwegian Institute of Public Health we have a lot of competency on environmental pollution and the effects on public health, air pollution, noise pollution, vector-borne diseases, antimicrobial resistance, mental health, and not at least, we do have a lot of competency on risk assessments. We have a lot of laboratories with high competence on experiments, laboratory experiments and we are in front regarding several methods on development system. So the NIPH, Folkehelseinstituttet, the Norwegian Institute of Public Health, we are ready to take action regarding the climate changes and their effects on public health. So thank you.

Roundtable discussion 

Thank you very much Ågpt and I would also like to extend my thanks to Renzo for an excellent talk and nice ability here to inspire us all on these issues and to link the concepts of decolonization and planetary health. So I have the honor to introduce our panel that will consist of Renzo and Ågot but also three students and those are Hector Ulloa, Jonas Kittelsen and Anne Sigrid Stokke, and I would like to give each of them the floor first to really comment on what you have heard and please give a couple of words on yourself as well when I give you the floor. And I will start with Hector who is working at SIH, SAIH, sorry. Who is working there and all students who pay their annual fee and the university will know that organization. Please Hector.

Thank you, John. Yes the abbreviation is very hard to we usually say SAIH in English and its the Norwegian students and academics International assistance fund, so I am the president at that organization currently. I am originally from Honduras, but I came to study my master degree here in Norway, at the University of Bergen. And then at SAIH we work mainly with academic freedom and access to higher education. However today we were invited here because we also started the debate about decolonization here in Norway back in 2018, when in one of our annual meeting, one of our local chapters of our local activists presented a resolution on the decolonization of academia, and after that we had a lot of criticism from professors and from students and then this debate originated around what decolonization of academia meant. So it is not very connected with the health and we don't work with health or planetary health, but something that I can pick from Renzo´s presentation, I think, that is very important is when he was talking about this decolonization efforts, he talked about the structural things and I think that is something that is sometimes get lost, gets lost when we talk about decolonization, it is that a lot of people see this word of decolonization or when we talk about decolonization of academia, they think it's very superficial and it is just about removing some authors or doing some small changes in the pensum (curriculum), or inviting different panelists to the events, which of course those are important steps, but once we talked about the structural things, how the colonial period laid down a lot of structures in our society when we talk about who has the power, who gets to say what is knowledge and what is not knowledge, why do we talk about alternative medicine for example, who established that there was one golden standard of medicine, why do we use these western standards as the absolute truth and those are the structural changes that we need to challenge when we talk about decolonization. It is not the superficial things, but it is those power relationships that were established many, many years ago and that even though we don't have slave trade anymore, we don't have colonizers and people who are being colonized in the world, as we did before, we still have these traditions and this in our subconscious we replicate a lot of these things from the colonial period that we need to challenge in the classrooms, we need to challenge in our research and we need to challenge the in just every profession, like Renzo clearly explained, it is also possible in planetary health and in the health sector to do to have a decolonization approach there.

Thank you very much Hector. Then Jonas, Jonas is a student at SUM, the center for development and environment, please.

Thank you very much. Hello, my name is Jonas, I'm a student at SUM and I'm a climate activist at Extinction Rebellion among others. It's such an honor to be here. I actually knew Per Fugelli. He was living 100 meters away from me when I grew up and I see Per in dr. Renzo especially on his clarity on justice, but also his tendency to go out of the comfort zone and really expand the conceptions of what is right, because I think that's you know, that's one of the most interesting things here, that when you expand the notion of health, it's not simply an individual thing. Like it's not a doctor's task to only fix an individuals health issue, but you're doing something that is collectively and social and that was one of the great Things with Per Fugelli and also with Renzo here. And that also means that you as a practitioner or as a doctor, you should be vocal and you should be aware of the power, of the power relations and the colonial structures that are apparent in our systems and I would also thank you UiO for centering this, because it's incredibly important, as you saw with deconstructing WHO, over eighty, or about 85% were from Europe and USA, so centering these voices and encouraging further to talk with, to centre indigenous people and marginalized communities is incredibly important because those who bear the consequences, they know very well what the solutions are, because they put the people and nature in front of profit.

So this, it's incredibly important that you understand that those who have the defining power of deciding is, must be must be centered around the justice and equity. Thank you.

Thank you Jonas, and then on to Anne, Anne Sigrid, medical student, University of Oslo. Please. Hi, my name is Anne Sigrid, I'm a medical student and I'm also enrolled in the medical student research program, with Anne as one of my supervisors actually, and I would just like to thank you Renzo for such an inspiring talk, and just it's very inspiring to hear someone talk about how physicians can make a difference regarding climate.

The climate crisis and climate justice and biological collapse, and I was, I'm going to draw on something Hector said about the power structures of decision-making in climate change, because you talked about how the conference, or the parties is not, the COP is not very well represented. It is better now than it was in the past and how this is of course again rooted in colonialism, how it is. Well, it is a conference of some elect parties it's not a conference of all parties involved, and I think that's really thought-provoking that. And even in Norway we do have actually some power to exert over who gets to make the decisions and who gets to talk at the actual conference, at the parties, so and of course other related climate change conferences, so I that was really interesting. So thank you.

Thanks, I think I would to try to incentivize more questions, I would probably like to use a couple of the questions in the Q&A and I just encourage all of you who are online to post more questions. Maybe start with the David´s question, that it really is about the role of private sector and if I sort of even strengthen his question is this a bit too much kumbaya in the sense of it's people, planet, but we're and of course the economy, but in the economy the major actors are private interest in many ways, so how do we engage private sector, private companies, multinational, local companies, Renzo, maybe, I think that question first goes for you, but please others as well but answer please. Sure, well thank you John Arne, and thanks to David for that question and it's not an easy one, otherwise the climate challenge should have been addressed way back right, and that's the very reason why there are 26 COPs, and there will be more because of the economy, of the industry, of the lobbying, of the private sector, and we really need to have a frank discussion as to what's the way forward. I actually want to highlight or also touch on the last part of the question, of David.

He was saying that you know are we going to ideological, ideologized the debate by you know, pushing for more planetary health perspective. The interesting thing is if it's coming from the planetary health side, climate justice, its ideology, but if it's coming from the private sector and capitalism it's called innovation, right, so you can see how we have double standards when it comes to, you know, in terms of the politics of ideas

I think that you know and you know in the Sunway Center, which by the way is supported by the private sector, but we happened to find a private sector entity, conglomerate in Malaysia, in Asia, that is so committed to sustainable development and planetary health and they're really committed to fixing its own backyard first, before we can start preaching to the rest of the world how to decarbonize, you know how to, you know be a more planetary health responsible organization, you know there's still hope in terms of engaging private sector entities, I think there are organizations that are serious about really being part of this climate action, that they are not just settling for greenwashing, which I also raised a while ago, but ultimately I think there has to be a very frank and inclusive discussion about the future of our Economy, the fortunate thing is that when the pandemic started, there were a lot of commentaries and I cited that in my November commentary about the economy that the planetary Health requires. Initially there was a lot of excitement, oh, that do we now have a window of opportunity to really think about the unthinkable reforms that we need, but fast forward we're talking about vaccines, the pharmaceutical sector has not changed dramatically, I'm sure John Arne is more expert than me when it comes to innovation and the pharmaceutical sector, but overall you know the economy is business as usual, and we missed, and we, if we do not get our acts together, we will miss this opportunity to actually institute and introduce those hard reforms, those hard transformations, you know in terms of building the doughnut economy, making it the reality and we in the Sunway Center, we are really committed to you know provoke, you know, and introduce these kinds of conversations. I know the WHO has an economic council for the, you know, or a council on the economics of “Health for all”, and I hope that will stimulate a much broader discourse about, you know, changing the economic model under which we operate. I'll stop there.

Thanks Renzo. So others would like to comment, and you can also use your race hand function, but I see the physical hand of Ågot and Hector, so Ågot first and then Hector. Thank you. As I mentioned and also Renzo and several others have mentioned, collaboration, that's an a keyword and that was also addressed by Per. So I think, yeah we shouldn't, the capitalism, the private sector, they are sometimes seen as enemies, but we shouldn't treat them like that, we have to collaborate and I think I should just give some PR for a project we are running at our institute now. We started the first of December a project where we will address sustainable food systems, together with nearly 40 actors from the private sector, from the public sector, from international actors as well. We will try to develop systems to label food with the nutritional quality and environmental impact, and that's part of a bigger you, that food systems must be adapted to climate, and we cannot reach that, a better system for food production and food consumption unless we have the industry on board, and the EU, the EU have large ambitions both for the food production, for the climate mitigation and so on, and the industry is on board. Innovation is tightly integrated with research and education, and I think there is a lot of what we can learn, both we in Norway and the world society as well from EU. Today as we speak, I think, the universities of Norway, Universitets og høgskulerådet, they have a big Conference, on where they launched their longtime plan, long-term plan for research and education in Norway, and I think there are also some of these aspects addressed. We cannot create the industry as enemy, we have to collaborate, that's important, and I my opinion in my opinion we see a lot of climate engagement and sustainability engagement in the industry, at least here in Norway, they are quite committed to sustainability. So I think we should should just bring them in and collaborate, that's the important thing. Thank you. Thanks Ågot. Hector and then Jonas and then I take the next question.

Thank you. I just wanted to make a brief comment on the stakeholders and that risk the current affairs and it's just not in a global health, but basically in every theme we talk about when we talk about decolonization. What we're talking about is that the thing, the way things are working up to this point need a change, so that resistance or that fear to resistance, it doesn't, it shouldn't be something that stopped us, because if we don't change things, or if we continue in the same way with The colonizing, then we are seeing the results already and it's that we are suffering, we're lacking in a lot of areas, and that is because there are certain people that have been benefiting from this structures, right. So when we talk about decolonizing, it is the natural thing and we need to be very comfortable with acknowledging that those people that are currently being benefited by those structures and by the way current efforts are, will post a resistance and they will fight back and that's why it is important for us to be able to bring down this like terms, down to the population, have everyone in society understand why they need to be on our side when we talk about decolonization or when we try and talk about talks because it is ultimately that societal support who will help us move forward and break those, that resistance that we will find but the resistance in natural. We can't stop because there will be resistance, or we can't not do things because we're afraid of that resistance, so I think that once we are able to have this like public discourse and be able to explain this, then the society has much more to win by engaging in this confrontation or in this attempt of change, then we will lose from this very specific stakeholders who are now benefiting from the current affairs or the current status of things.

Thank you, Jonas. Yeah, I very much agree about COP26 and vaccines and where we are. I was at the COP26 as a Nordic youth representative, and at last day there was the people summit, where the global community gathered, and that's the most powerful hour in my life. There were all the constituencies that the UN could hold, each speech one speech each, and everyone cried, and they were absolutely raging for that the global, the rich are leaving the global south or the marginalized communities behind. They said why are you willfully killing us for your money, and indigenous people started to sing, everyone cried in the room and after 1,5 hours everyone just left and left the whole conference Because, in protest.

So that's the gap we're talking about here, and it's important to understand that there is a huge gap. And so the reason, you know we didn't have the COP as we wanted, there was some good things yes, but it was not because of the solutions or will, but because those in power doesn't want to change efficiently, fast enough and that shows us that real leadership is within those marginalized communities, those who bear the real consequences of climate change really knows what's going on, and they have the solutions ready, and that's why decolonization is one of the most powerful tools we have to true leadership in climate change and biodiversity, solving the biodiversity crisis, because they're on the forefront and they know what can be done and must be done. Yeah, I just want to highlight that. Thank you, Jonas. There's one question, I think it was anonymous, but it's really about. No, actuallu two anonymous, yes exactly, because the, in a way the pandemic has Illustrated also how vulnerable we are in the global supply chains, vaccines and other medical groups, and of course PPEs are other examples, and the question is really related to whether this will also become a change, so there will be more local production, like less transport of goods and how you see that as a consequence coming out of the pandemic, and how can that relate and how can that, I guess foster a planetary change or planetary health change agenda. Renzo, would you like to go first? Sure, yeah, and I guess I will build on my earlier remarks, you know we were given a window of opportunity, there was some excitement of coming from different corners, about oh let's move to the new normal, that is and usher a post covid recovery that is green, healthy and just, but I am quite concerned that because of the unfortunate, you know, focus right now that we have on for example the vaccine inequality, which is both a distraction, but also that's just a result of the business as usual affairs, we might be missing this rare opportunity that was given to us, to institute these longer-term and more lasting reforms in not just healthcare, but also as mentioned in the chat box, transportation, food production, etc. And so well, unfortunately the pandemic is far from over, new variants are coming in, and so this is going to be prolonged and prolonged, and you know, this might even move towards endemicity, this pandemic, but let's not waste the time, you know, that we are being given to really expand some of the initial signals that we're seeing in terms of reforms in the way we travel, the reforms that we, in terms of producing food for our local communities, you know for example even within healthcare alone, initially I was quite understanding of health care's neglect of climate change and environmental sustainability, at the beginning of the pandemic, but we're already on year two, and we should not be rolling out vaccines that do not embrace sustainability principles, you know, from the way they're transported to the way they are produced. Health care, for example, should start thinking about decarbonizing Itself, so that it doesn't become part of the climate crime, because addressing climate change will also prevent the next pandemic. I've already mentioned about climate change are also in driving infectious disease outbreaks, and of course going back to COP26, one of the highlights of COP26 is that nearly 50 countries made strong commitments to transform their National Health Systems to become low-carbon and climate-resilient. That's good signal, we should continue to to support that, but we need more countries and eventually the whole global health sector to start operating as if borrowing from Greta Thunberg, the world is on fire. Unfortunately we're not doing that.

Ågot, please. Just a short comment on that, how the covid-19 could change the world. We know that reduced emissions of climate gases, reduced consumption and production of CO2, they are two main challenges, they must be solved. But the third main unique challenges of to the world is to reduce the loss of nature, the loss of biodiversity, and I think we don't, we don't know exactly where the covid-19 virus came from, but there is a theory that it was transferred from wild animals to humans and that's a sign that trespassing nature's boundaries, that's a main threat to human public health, and I think that's something we can exploit with the pandemic, increase the understanding of how important biodiversity and nature in fact is for public health and for the climate at all. So I think that's also a main mission. For me coming from this University at Ås, where ecology and nature is a main issue, it's easy to convey such a kind of message as well. So, but I think that's one of the main things we can get out of the pandemic and just an increased understanding of how important nature and biodiversity actually is. Thank you Ågot, and I should say that that is definitely an emerging sort of view and interest now what they call the prevention at the source, so to reduce the likelihood of zoonotic spillovers, we really need to sort of link climate change, environmental change issues with health and the risks of the outbreaks. So it's a good opportunity for a One Health approach. I think we have time for a couple of questions more and maybe to link them because Ernst Kristian Rødland is citing the fact that Norway is, has been listed at least, as the third least climate concern population. I know there has been debate about that poll, but at least it's the results in one poll and then his question to, I guess in particular those outside Norway and in particular Renzo then, how can we increase awareness of climate change issues and planetary health in Norway, and maybe we can also link that with Sine Grude´s question on what kind of advice do you have both Renzo, but also the rest of you as students, how can they address these issues, how can they make a change in the direction both for decolonization as well as more emphasis on planetary health, and I would like to actually challenge all of you on that, how can an ordinary student, but no one are ordinary, all are unique, how can they make an action based on this. Renzo first, and then I just, I go round the floor, maybe it ends with you Ågot, and let the students first. Sure. Please Renzo. So yeah, well regarding the Norwegian predicament, right, in terms of limited climate awareness, I think this is where planetary health and even decolonization can really help. You know in public health and I'm sure you know John Arne and I, you know we all started as public health. We always think about the health of our own population, of the people who we see and we encounter in the street, in our communities and that's important. Global health has expanded that view and now we're all concerned about the health of fellow humans, living in other places, especially those who are less privileged, and that's of course a traditional global health definition, that they should be challenging, because global health is really about the health of people from both rich and poor countries alike. But planetary health even further expands that, and makes us all realize about our commonality and our interconnectedness as one species, as one human species right. I think that's very special that perhaps the earlier concepts that I described do not really emphasize that much, right. There's actually one term or phrase, it was also introduced in the Lancet commentary, that planetary health is also about civilizational health, so we're talking about the survival of the civilization, and I hope that are Norwegian colleagues, now you've seen some clips from the Philippines, climate change is a reality here. It's not just an IPCC Report, and I hope that planetary health and this idea of decolonization, will you know at least touch everybody's minds and hearts, that yes we are one humanity and we should be acting on these pressing challenges that we share all together. So I hope that that's one. And I guess in terms of making these some more concrete, especially for you know the young medical students, I think the zoomification that has created by this pandemic should allow us to gain more opportunities to connect with people who probably will never be able to meet within our lifetime, if we're not connected digitally. I probably would not be meeting you and be addressing you through this lecture if not for Zoom, or it might need to wait, you know for in the future. But we now have this perfect, great opportunity. I mean the digitalization is a double-edged sword, we're also seeing the problems with digital technology, with the mental health challenges that it brings in the fake news that it propagates, but also the digital you know platform also allows us to really connect with one another, you can see films and you can come to the Philippines, you know visually and graphically through these media, and so let's take advantage of that and I believe in the young generation, perhaps the most knowledgeable and most equipped generation that the history of humanity has ever seen before, because again of the technologies that we have and the knowledge that is within our fingertips reach, through our fingertips, so I hope that is a strong encouragement enough to our young people here to step up, because while we have many challenges that we're confronting, we also have many blessings and opportunities that we can, you know use to our own advantage. I'll stop there.

Thank you. Hector, would you like to give some suggestions to the students listening in?

Yes, it's a hard question, but I think when it comes to student engagement, something we have seen a lot in the decolonization debate here in Norway, is that the most important thing is to talk about it and especially in the classroom, you know, inside we have, we follow the ideas of these pedagogist called Paulo Freire, who talked about the educational system not being a banking system, where the teachers and the people with knowledge come and you memorize and they give you all, but he said that students must have had an active role in the classrooms and they should criticize, they should be critical about what the teacher is telling them, they should be critical about the knowledge they're receiving, they should ask questions and they should engage in that debate, and I think when we talk about this decolonization thing and just basically any other topic way in an academic environment. That's the role that students should have and that's when you usually see that engagement increases when they're having an active role, they are participating, they are criticizing, and they are questioning those established truths, and I think that might be my one advice. That's what we see in the decolonization debate now, it's not SAIH who is leading. We had, it's not part of our Action Program even anymore and we see that the topic keeps on coming up and up in different universities because it is students who are talking about it, we're bringing it up and I think that is the easiest way, when you speak up in your classroom, when you ask questions, when you're crazy, not only are engaging with your teacher, but all your classmates are listening to you as well and they are also being influenced by that, and then they can also repeat that and get interested in these topics that you're passionate about, so my advice would be speak up and be critical.

Great advice Hector. Jonas.

Yeah very much agree with Hector, and besides talking, I also think action is absolutely critical. So if you're a student, like look for projects, look for, try to search for ways you can contribute. I mean I as an activist, I always, I do civil disobedience and that type of stuff, so it might be a bit off record, but yeah, search for organizations that you find interesting and believe in, and act, because we all see talking is extremely important to change conceptions and values, but you need action in the end. So yeah, that's my core thing. Thanks Jonas, to speak and act. And then to you on Anne Sigrid. So I'm going to be linking back to what Ågot said about why is it important that we in Norway do research on and make policies on the link between climate change and public health, even though it's not very present issue here and also what Hector said about speaking up, and I'm I would talk about the to address and to be advocates for the responsibility of the Global North when it comes to climate injustice. So especially, we here have a responsibility, even though climate change doesn't in a large extent affect public health in Norway, we do have a moral obligation to help minimize the effects of climate change as we have contributed to climat change in a larger, to a larger extent, like the figure that Renzo showed with the countries, with the input into climate change and then how it affects us. So I think we really have a responsibility to speak up about how we have a moral obligation to help minimize the effects that climate change has on the Global South, and finally I would also like to remark with speaking up to not accept green washed explanations for things, which is very much something we do here, especially with the oil sector and I think we need to just stop accepting those green washed explanations, because and now even those green washed explanations are aimed at the youth, trying to greenwash Norwegian oil for the youth which is a very, well I think a very dangerous rhetoric possibly. So thank you.

Thanks Anne Sigrid, and then Ågot. Thank you. You are students and you have the power to get to convince your professors, your university leaders to change the curriculum. That's also something you should think about, and I think public health and environmental health become distinguished, they are linked. So addressing this in the curriculum, I think that's, I don't know, I'm not a medical doctor and I have not studied your current curriculum, but I supposed that there is not that much about environmental health in your curriculum today. And I think also that when dealing with climate change and health I think you have medical doctors who come into a lot of dilemmas, several controversies, on saving lives versus saving the planet. I think there will be dilemmas there. We have had the debate now ove,r regarding the distribution of vaccination, vaccines, in the industrialized countries versus the the low-income countries. This is kind of dilemmas that you probably also will face when you come into your practice and will deal with consequences of climate changes and public health. Regarding food, as I mentioned, we are working heavily with the food and healthy food and healthy planet, and there will be several dilemmas there also. What is healthy for you, is that also healthy for the planet. We don't know actually, and there will be several dilemmas, and I think that's the problems that should be addressed by the students, both within the curricula and in the in the society,in the debate, the public debate. Thank you. Thank you Ågot and before handing the floor back to Anne, to close up, I would really like to thank the full panel for this engaged discussion and also indeed in particular Renzo who came all the way from Philippines at least in a very alive way and I think you have demonstrated that you have well deserved place in the line of lecturers, giving this annual lecture for Per Fugelli. Per was good with words and with new concepts and I think you have demonstrated that ralent as well. You spoke about Per´s infectious energy and definitely you, I think you have infected many of us today and many of the listeners with speaking about serious problems with a smile Renzo, so that's good. Keep on smiling.

Anne, over to you.

Closing remarks by Anne Kveim Lie

Thank you so much, I mean thank you so much to our panelists, our great panelists for giving us a rich perspectives and thank you above all, thank you also to the audience, to Ågor, to John Arne and to the audience for your questions, but thanks above all to Renzo for weaving I mean, I must admit I was a bit afraid when you put the title to me, because I know, you know many of us students are not familiar to the concepts of decolonization or planetary health, but you managed to engage us all and provide this rich lecture, also we you know including these really, I think you brought the current problems from the Philippines into our rooms, and I'm so grateful for that. And I can also inform, I would like to inform you all, inspired by Ågot´s comments, that we have actually now, I've headed a working group that have produced a manual or a document, a report, on how to integrate sustainability and climate and nature, natural devastation into the curriculum in medical schools, so but I mean maybe we have to change that after this lecture and focus more on the you know decolonizing global health as well by way of planetary health, I don't know but it's at least, this is a report it's about to be finished and it's been accepted by the deans, so there will be change in the medical curriculum. So just to say that. But everyone, this will conclude this year's Per Fugelli lecture. Thank you so much Renzo and to all of you if you have any suggestion for the next year's Per Fugelli lecture, we welcome suggestions and you can send them, email them to me or to John Arne or to anyone. So thank you so much and happy holidays when that comes. Thank you everyone, stay safe and see you in the future. And thank you Gabriella for bringing us safely through this, I forgot to say that. Thank you so much to Center for Global health and Gabriella in particular for guiding us through this.